HISTORY OF PEDIATRICS 521 



a percentage of 35, and Spratling, who has lived among epileptics 

 nearly a dozen years, 66. 



Epilepsy is acknowledged to be one of the causes of imbecility, 

 or genuine idiocy. In very many instances it should be considered 

 as the coordinate result of congenital or acquired changes in the 

 skull, the brain, and its meninges, and particularly the cortex. 

 In a single idiot institution, that of Langenhagen, 15% to 18% of 

 the 395-668 inmates were epileptic; in another, Dalldorf, 18.5% 

 to 24.3% of 167-344; in a third, Idstein, 36% of 101 (Binswan- 

 ger, in Nothnagel, Syst. Path. u. Ther., vol. xn, 1310). 



Its main causes are central. External irritations, worms, calculi, 

 genital or nasal reflexes, may be occasional proximate causes. But 

 cauterization of the nares, and still more, circumcision, and clitori- 

 dectomy prove more the helplessness or recklessness of the at- 

 tendant than the possibility of a cure. The individual cases of 

 recovery by the removal of clots, bones, or tumors, are great and 

 comforting results, but if epilepsy and its relations are ever to dis- 

 appear, it is not the knife of the surgeon but the apparatus of hu- 

 man foresight and justice that will accomplish it. Most of the causes 

 of epilepsy are preventable. To that class belong syphilis and alco- 

 holism in various generations, rachitis, tuberculosis, and scrofula, 

 many cases of encephalo-meningitis, and most cases of otitis. A 

 question is attributed to a royal layman, "If preventable, why 

 are they not prevented?" If there is a proof of what Socrates and 

 Kant said, namely, that statesmanship cannot thrive without the 

 physician, it is contained in the necessities of epilepsy. Preven- 

 tion, preventives, and hygienic, medicinal, and surgical aids have 

 to be invoked, unfortunately with slim results so far. 



The influence of hereditary syphilis on the diseases of the nerv- 

 ous system has been studied these twenty years, both by neuro- 

 logists and podiatrists. Its results are either direct - - that means 

 characteristically syphilitic or metasyphilitic that means merely 

 degenerative. Hoffmann cured a case of syphilitic epilepsy in a 

 girl of nine years in 1712. Plenk describes convulsions and other 

 nervous symptoms depending on hereditary syphilis, and Nils Rosen 

 de Rosenstein describes the same in 1781. The literature of the 

 latter part of the eighteenth and of the first half of the nineteenth 

 century is silent on that subject, though the cases of affections of 

 the nervous system depending on hereditary syphilis are very fre- 

 quent (thirteen per cent of all the cases, according to Rumpf die 

 Syph. Erk. d. Nervensy stems, 1889). Jullien (Arch. Gen., 1901) 

 reports 206 pregnancies in 43 syphilitic marriages. Of the children, 

 162 remained alive. Half of them had convulsions or symptoms 

 of meningitis. 



According to Nonne (Die Syph. d. Nervens., 1902) hereditary 



